How do I get access to my relative’s medical records and regular updates when a county guardian controls decisions? – North Carolina

Short Answer

In North Carolina, when a county guardian (usually a disinterested public agent) is guardian of the person, that guardian controls medical decisions and access to confidential records unless the court orders otherwise. A relative generally must either (1) obtain the guardian’s written authorization for releases and updates, or (2) file a motion with the clerk of superior court to modify the guardianship order so the relative is added as co-guardian or given limited decision-making and information rights. The clerk can tailor the guardianship to share authority and require ongoing communication with family.

Understanding the Problem

The narrow question here is: under North Carolina guardianship law, how can a relative of an incompetent adult obtain access to medical records and regular medical updates when a county guardian has been appointed to make personal and health care decisions? This comes up when a public guardian manages decisions for an adult in a facility, and a family member wants to participate in care planning, receive information, and help with outings or appointments, without assuming full financial responsibility or full guardianship. The focus is on changing or clarifying the existing guardianship so that the family member can lawfully receive confidential information and share some health-care decision-making authority.

Apply the Law

North Carolina law gives a guardian of the person broad authority over a ward’s care, including health care decisions and the ability to consent to treatment and releases of information, but the clerk of superior court can limit or share those powers. The main forum is the Special Proceedings division of the clerk of superior court in the county where the guardianship is filed. Changes are typically requested through a motion in the cause under the existing guardianship file; there is no single fixed deadline, but timing matters if medical decisions are ongoing or urgent.

Key Requirements

Existing guardianship and roles: There must be an active adult guardianship, usually with a guardian of the person (often the county department or another disinterested public agent) controlling medical decisions and information.
Legal basis to share or modify authority: The clerk must have a reason, grounded in the ward’s best interests and current abilities, to modify the order—such as appointing a co-guardian, assigning limited powers to a relative, or directing the guardian to involve the family and share information.
Proper request and proof: A relative or other interested party must file a written motion with the clerk in the guardianship case, give proper notice, and present evidence (for example, about involvement with the ward, communication problems, and why more family participation benefits the ward).

What the Statutes Say

N.C. Gen. Stat. § 35A-1241 (Powers and duties of guardian of the person) – gives the guardian authority over custody, residence, and consent to medical and other professional care.
N.C. Gen. Stat. § 35A-1242 (Status reports for incompetent wards) – requires certain guardians to file periodic status reports and allows interested parties to move to modify the guardianship based on those reports.
N.C. Gen. Stat. § 35A-1208 (Authority for health care decisions) – addresses how a court-appointed guardian’s health-care authority relates to any existing health care power of attorney.
N.C. Gen. Stat. § 122C-52 (Right to confidentiality) – protects confidential mental health records and restricts disclosure except as allowed by statute.
N.C. Gen. Stat. § 122C-53 (Exceptions; client) – allows release of certain confidential information with consent of the client or “legally responsible person,” which will often be the guardian.
N.C. Gen. Stat. § 8-53 (Communications between health care provider and patient) – governs medical privilege and allows disclosure with authorization from the patient or, in some situations, by court order.
N.C. Gen. Stat. § 34-3 (Veterans’ benefits guardians) – allows appointment of a guardian when the Veterans Administration requires one before paying benefits.

Analysis

Apply the Rule to the Facts: Here, a sibling lives in a care facility in North Carolina with a county guardian of the person handling decisions. The sibling relative is actively involved, visits often, and wants to share in care decisions, receive medical updates, and help with outings without taking on full guardianship or financial responsibility. Under North Carolina law, that relative can ask the county guardian to sign written medical releases and communication authorizations, or can file a motion with the clerk of superior court to modify the guardianship—requesting co-guardianship or limited powers to participate in decisions and to receive records and regular reports. If the ward receives veterans’ benefits and the VA requires a guardian, the structure of the guardianship may also need to stay compliant with Chapter 34, but the clerk can still tailor personal-care powers and communication expectations.

Process & Timing

Who files: An “interested party,” such as a close relative, files. Where: With the Clerk of Superior Court, Special Proceedings division, in the North Carolina county where the guardianship file is pending. What: A written motion in the cause under the existing guardianship file number, requesting modification of the guardianship order (for example, appointment as co-guardian of the person or granting limited authority to participate in medical decisions and receive records), plus any local forms required by the clerk. When: Any time after appointment if circumstances show that more family involvement would serve the ward’s best interests; acting before major treatment decisions or placement changes is often helpful.
The clerk issues notice of hearing to the current guardian, the ward, and other interested parties. The county guardian may file a written response or simply appear at the hearing. Timeframes vary by county, but a hearing is often scheduled several weeks out, depending on the court’s calendar and the need for medical evidence.
At the hearing, the clerk hears testimony from the relative, guardian, and possibly facility staff or treating providers. The clerk may (a) leave the current arrangement in place but direct better communication, (b) appoint the relative as co-guardian of the person with shared or defined powers, (c) convert the guardianship to a more limited one that preserves certain rights for the ward and gives the family a defined role in information-sharing, or (d) make other tailored changes. A written amended order is entered and provided to the parties; health care providers and the veteran’s care system can then rely on that order when communicating with the family.

Exceptions & Pitfalls

Facilities and agencies must comply with federal privacy rules and North Carolina confidentiality statutes. Without the guardian’s written consent or a court order, staff may legally refuse to release detailed medical records or discuss treatment, even with close relatives.
If the ward previously signed a valid health care power of attorney naming an agent, the court must coordinate the guardian’s authority with that document. The clerk may need to address whether the health care agent’s powers are suspended or remain primary.
In mental health or substance-use settings, stricter confidentiality rules may limit what even a guardian can re-disclose. Written, specific authorizations and careful wording in a court order help reduce friction.
When the ward receives veterans’ benefits through a VA-related guardianship, additional federal rules and VA procedures can affect who receives records. The county guardian and family often must work with VA staff to ensure required forms and releases are in place.
Common mistakes include assuming that being “next of kin” automatically confers access to records, relying on informal promises rather than written authorizations, or requesting full guardianship when a more limited arrangement would better fit the relative’s availability and financial constraints.

Conclusion

Under North Carolina law, a county guardian of the person holds primary authority over an incompetent adult’s medical decisions and access to records, but the clerk of superior court can modify that structure to involve a committed relative. To gain regular updates and access to medical records, a relative typically must secure written authorizations from the guardian or ask the clerk, by motion in the existing guardianship case, to add co-guardian or limited decision-making and information rights that reflect the ward’s best interests.

Talk to a Guardianship Attorney

If a county guardian controls a loved one’s medical decisions and information and a relative wants a defined role in care and access to records, our firm has experienced guardianship attorneys who can help explain options and prepare a tailored motion in the guardianship case. Call us today at (919) 341-7055.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.